J Korean Med Assoc.  2014 Nov;57(11):934-940. 10.5124/jkma.2014.57.11.934.

Diagnosis and acute management of anaphylaxis

• Jeong JW

• KMID: 1958394
• DOI: http://doi.org/10.5124/jkma.2014.57.11.934

Abstract

Anaphylaxis is a severe systemic allergic reaction with a rapid onset that is potentially fatal. The incidence of anaphylaxis is increasing. The diagnosis of anaphylaxis is based primarily on a detailed history-taking of the episode, including information about all exposures and events in the hours preceding the onset of symptoms. Target organ involvement is variable. In general, symptoms occur in 2 or more body systems: the skin and mucous membranes, upper and lower respiratory tract, gastrointestinal tract, cardiovascular system, and central nervous system. Epinephrine is the primary medical therapy, and it must be administered promptly. Intramuscular injection of epinephrine into the antero-lateral thigh is the preferred injection route in an urgent situation. Prevention of recurrence depends primarily on optimal management of patient-related risk factors, plus strict avoidance of the causative allergen or other triggers. When indicated, the practitioner should prescribe self-injectable epinephrine and should educate the patient on how to use it.

Keyword

Anaphylaxis; Epinephrine

MeSH Terms

Anaphylaxis*
Cardiovascular System
Central Nervous System
Diagnosis*
Epinephrine
Gastrointestinal Tract
Humans
Hypersensitivity
Incidence
Injections, Intramuscular
Mucous Membrane
Recurrence
Respiratory System
Risk Factors
Skin
Thigh
Epinephrine

Figure

• 

  Figure 1 Training kit of self-injectable epinephrine (Epipen; Mylan, Basking Ridge, NJ, USA).

Reference

1. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C, Ortega Martell JA, Platts-Mills TA, Ring J, Thien F, Van Cauwenberge P, Williams HC. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004; 113:832–836.

2. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, Brown SG, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, OConnor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW. Second symposium on the definition and management of anaphylaxis: summary report. Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006; 117:391–397.

3. Simons FE. World Allergy Organization survey on global availability of essentials for the asses-sment and management of anaphylaxis by allergy-immunology specialists in health care settings. Ann Allergy Asthma Immunol. 2010; 104:405–412.

4. Yang MS, Lee SH, Kim TW, Kwon JW, Lee SM, Kim SH, Kwon HS, Park CH, Park HW, Kim SS, Cho SH, Min KU, Kim YY, Chang YS. Epidemiologic and clinical features of anaphylaxis in Korea. Ann Allergy Asthma Immunol. 2008; 100:31–36.

5. Lim DH. Epidemiology of anaphylaxis in Korean children. Korean J Pediatr. 2008; 51:351–354.

6. Lee SY, Kim KW, Lee HH, Lim DH, Chung HL, Kim SW, Lee SY, Yang ES, Lee J, Kim KE. Incidence and clinical characteristics of pediatric emergency department visits of children with severe food allergy. Korean J Asthma Allergy Clin Immunol. 2012; 32:169–175.

7. Simons FE, Ardusso LR, Bilo MB, El-Gamal YM, Ledford DK, Ring J, Sanchez-Borges M, Senna GE, Sheikh A, Thong BY. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011; 4:13–37.

8. Kim MJ, Choi GS, Um SJ, Sung JM, Shin YS, Park HJ, Ye YM, Nahm DH, Lee SY, Park HS. Anaphylaxis: 10 years' experience at a university hospital in Suwon. Korean J Asthma Allergy Clin Immunol. 2008; 28:298–304.

9. Ye YM, Kim MY, Kang HR, Kim TB, Sohn SW, Koh YI, Jang GC, Kim CW, Jee YK, Hur GY, Kim JH, Kim SH, Choi GS, Lee SG, Park HS. KAAACI Work Group on Urticaria/Angioedema/Anaphylaxis. Anaphylaxis in Korean adults: a multicenter retrospective case study. Korean J Asthma Allergy Clin Immunol. 2012; 32:S226.

10. Jang GC, Kang HR, Ye YM, Kim HW, Shin MY, Kim JH, Choi SH, Jung JW, Lee SJ, Jin HJ, Yang ES, Lee SY, Park HS, Ahn YM. Review of anaphylaxis report and questionnaire survery of hereditary angioedema in Korea. Korean J Asthma Allergy Clin Immunol. 2011; 31:S663–S685.

11. Simons FE, Ardusso LR, Bilo MB, Dimov V, Ebisawa M, El-Gamal YM, Ledford DK, Lockey RF, Ring J, Sanchez-Borges M, Senna GE, Sheikh A, Thong BY, Worm M;. 2012 Update: World Allergy Organization guidelines for the assessment and management of anaphylaxis. Curr Opin Allergy Clin Immunol. 2012; 12:389–399.

12. Lieberman P, Nicklas RA, Oppenheimer J, Kemp SF, Lang DM, Bernstein DI, Bernstein JA, Burks AW, Feldweg AM, Fink JN, Greenberger PA, Golden DB, James JM, Kemp SF, Ledford DK, Lieberman P, Sheffer AL, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol. 2010; 126:477–480.

13. Jang GC, Chang YS, Choi SH, Song WJ, Lee SY, Park HS, Kang HR, Ye YM, Jin HJ, Shin MY, Lee SJ, Kim HO, Kim J, Jung JW, Moon HB, Ahn Y. Overview of anaphylaxis in Korea: diagnosis and management. Allergy Asthma Respir Dis. 2013; 1:181–196.

14. Sicherer SH, Simons FE. Section on Allergy and Immunology, American Academy of Pediatrics. Self-injectable epinephrine for first-aid management of anaphylaxis. Pediatrics. 2007; 119:638–646.

15. Rudders SA, Banerji A. An update on self-injectable epinephrine. Curr Opin Allergy Clin Immunol. 2013; 13:432–437.